| E1399 | Durable medical equipment, miscellaneous | 5 | 20 | 1,330 | $1,380 | $5.3M |
| B4161 | Enteral formula, for pediatrics, hydrolyzed/amino acids and peptide chain proteins, includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding… | 7 | 10 | 1,020 | $540 | $2.7M |
| B4035 | Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape | 11 | 20 | 6,040 | $210 | $2.1M |
| B4149 | Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral… | 5 | 10 | 1,980 | $330 | $1.5M |
| B4160 | Enteral formula, for pediatrics, nutritionally complete calorically dense (equal to or greater than 0.7 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals,… | 8 | 10 | 2,060 | $120 | $716.9K |
| T4527 | Adult sized disposable incontinence product, protective underwear/pull-on, large size, each | 19 | 50 | 1,230 | $90 | $667.8K |
| B4153 | Enteral formula, nutritionally complete, hydrolyzed proteins (amino acids and peptide chain), includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral… | 6 | 10 | 1,140 | $450 | $561.4K |
| A4385 | Ostomy skin barrier, solid 4 x 4 or equivalent, extended wear, without built-in convexity, each | 3 | 10 | 890 | $70 | $537.7K |
| E0465 | Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) | 7 | 10 | 690 | $610 | $533.7K |
| T4528 | Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each | 21 | 40 | 1,140 | $90 | $504.3K |